双支架留置术治疗恶性气管、食管狭窄

Double stents indwelling in malignant tracheal and esophageal stenosis

目的探讨气管、食管双支架留置术治疗恶性气管、食管狭窄的安全性和临床疗效。方法 12例恶性肿瘤造成气管、食管狭窄患者,其中男性8例,女性4例;年龄38～66岁,平均年龄48.8岁。术前行食管造影及螺旋CT气道三维重建检查,明确气管、食管狭窄的部位、程度及是否存在气管食管瘘。7例以吞咽困难为主要症状患者首先置入食管支架,5例以呼吸困难为主要症状患者首先置入气管支架。食管支架选用覆膜镍钛合金支架,气管、支气管支架选用自膨胀网状镍钛合金支架。所有患者都留置气管、食管双支架。结果所有患者成功置入气管、食管双支架,手术成功率100%。7例首先留置食管支架者,5例在食管支架置入后立即出现呼吸困难,需马上留置气管、支气管支架,另2例在24h内逐渐出现呼吸困难,置入气管、支气管支架后缓解。5例首先留置气管支架者,支架留置后呼吸困难缓解,之后留置食管支架操作顺利。所有患者留置气管、食管双支架后呼吸困难、吞咽困难症状明显改善。2例合并气管食管瘘患者,双支架留置后瘘口闭合。12例患者术后生存1.5～6.2个月,1例因肿瘤的过度生长而发生食管再狭窄,再次置入食管支架后症状缓解。结论气管、食管双支架留置术是治疗恶性气管、食管狭窄安全、有效的治疗方法。对于同时伴有气管、食管狭窄的患者,应首先置入气管支架,以防止食管支架膨胀压迫气管,加重气管狭窄引起窒息。

Objective To evaluate the efficacy and safety of double stents indwelling in the treatment for malignant tracheal and esophageal stenosis.Methods Twelve patients with inoperable malignant tracheal bronchial and esophageal stenosis, male 8, female 4, aged 38-66 years, mean age 48.8 years, were indwelled stents by fluoroscopic guidance.Seven cases with dysphagia as the main symptom were implanted esophageal stents firstly and then tracheal bronchial stents.Five cases dysponea as the main symptom were implanted tracheal bronchial stents firstly and then esophageal stents.The nickle titanium coated stents were chosen for esophageal stenosis and self-expanding nitinol stents for tracheal bronchial stenosis.Results All tracheal bronchial and esophageal stents were successful implanted and well-tolerated in all patients.Suffocation appered immediately in 5 cases after esophageal stents implantation and dyspnea appeared in 2 cases within 24 hours due to tracheal compression in those esophageal stents were implanted firstly, and whose dyspnea and suffocation were immediately relieved after the tracheal bronchial stents implantation.Two cases with esophago-tracheal fistula were cured after double stents were implanted.The postoperative survival period of all patients were 1.5 months to 6.2 months（mean 3.4 months） after stent implantation.Dysphagia reoccurred in 1 case due to tumor overgrowth and relieved after another stent implantation.Conclusion Double stents indwelling is safe and effective approach in patients with malignant tracheal bronchial and esophageal stenosis.These results demonstrate that tracheal bronchial stents should be implanted firstly and then esophageal stents be implanted to avoid suffocation due to tracheal bronchial compression by the esophageal stent.